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� <br /> FIREPLACES <br /> Gas factory fireplace <br /> Wood burnin� factory fireplace with flue <br /> Wood Stove <br /> V1ood stove with flue <br /> Branci N ame i�iouel i�u. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: �allons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERVIIT FEE CALCULATION <br /> l. 1.2�% of Contract Price* or Minimum Fee ($3�.00) <br /> C���j�� x .0125 $ �� <br /> (contract price) <br /> 2. State SurcharQe. ** Add the State Building Code Division <br /> Surcharge to each permit. c�g �j�j. C�� x .0005 $ a - � � <br /> or $.50, whichever is greater (contract price) <br /> 3. PostaQe and HandlinQ (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �7� . `�� <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount char�ed for the permitted <br /> work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the customer <br /> for the work done. If any material, equipment, labor, or uistallation are fumi.hed by the owner, tenant or <br /> any other party the reasonable market value of such items must be added to the estimated cost or contract <br /> price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, the City may <br /> request the submission of a signed copy of the actual contract. <br /> ** The STATE SURCHARGE is .0005 of the contract price under�1,000,000 or $.50 - whichever is greater. <br /> For valuations over $1,000,000 call the Department of Inspectional Services for the price. <br /> The undersigned here�y apglies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the Minnesota <br /> State Building Code, and certi�es that all statements made on this application are complete, true <br /> and correct. <br /> Applicant's Si�natu • �1V Date: ��� <br /> .�` <br /> Approved By: Date: <br />